Xian Jian-Chun, Xu Hong-Tao, He Yi-Lin, Shen Mei-Long, Chen Ya-Bao, Zhang Li-Xin, Xiao Li, Li Yang, Han Li-Bin, Li Hao, Lu Lun-Gen
Department of Liver Disease, Taizhou Peoples' Hospital, Taizhou Jiangsu Province 225300, China.
Zhonghua Gan Zang Bing Za Zhi. 2011 Jun;19(6):431-5.
To investigate the relevant factors of liver histological changes in chronic hepatitis B (CHB) patients with mildly elevated ALT and to explore the clinical values of these factors on anti-viral treatment.
A total of 152 CHB patients with mildly elevated ALT (less than 2 x ULN) who underwent liver biopsy were included in the study. Correlations between routine laboratory markers, liver histological inflammation grade and fibrosis stage were statistically assessed by Spearman correlation analysis, one-way ANOVA, area under the curve (AUC) of the receiver operating characteristic curves (ROC) and Logistic regression statistical analysis.
All patients in the study showed various hepatic histological damages. Among the 152 patients 50 (32.9%) were found with inflammation grade 1 (G1), 42 (27.6%) with G2, 46 (30.3%) with G3 and 14 (9.2%) with G4. 16 patients (10.5%) were found with fibrosis stage 2 (S2), 25 (16.5%) with S3 and 41 (27.0%) with S4. Routine laboratory markers Alb, BPC and WBC were significantly correlated with hepatic histological inflammation grade and fibrosis stage. Marked liver fibrosis and moderate to severe liver damage were significantly higher in patients aged more than 40 years as compared to those less than 40 years of age (P = 0.002, P = 0.010). The regression equation P = 1/[1+e-(9.36250-1625Alb-0.0234BPC)] was established with sensitivity and specificity of 83.3% and 65.0%, respectively.
67.8% of CHB patients with mildly elevated ALT have significant injury to the liver tissue. CHB patients aged more than 40 years have a significant increase of marked liver fibrosis and moderate to severe liver damage. The regression equation is valuable to predict whether CHB patients need antiviral therapy or not.
探讨慢性乙型肝炎（CHB）患者谷丙转氨酶（ALT）轻度升高时肝脏组织学改变的相关因素，并探讨这些因素在抗病毒治疗中的临床价值。
本研究纳入152例接受肝活检的ALT轻度升高（低于2倍正常上限）的CHB患者。通过Spearman相关分析、单因素方差分析、受试者操作特征曲线（ROC）的曲线下面积（AUC）以及Logistic回归统计分析，对常规实验室指标与肝脏组织学炎症分级和纤维化分期之间的相关性进行统计学评估。
本研究中的所有患者均表现出不同程度的肝脏组织学损伤。152例患者中，50例（32.9%）炎症分级为1级（G1），42例（27.6%）为G2，46例（30.3%）为G3，14例（9.2%）为G4。16例（10.5%）纤维化分期为2期（S2），25例（16.5%）为S3，41例（27.0%）为S4。常规实验室指标白蛋白（Alb）、血小板计数（BPC）和白细胞计数（WBC）与肝脏组织学炎症分级和纤维化分期显著相关。40岁以上患者的显著肝纤维化和中度至重度肝损伤明显高于40岁以下患者（P = 0.002，P = 0.010）。建立回归方程P = 1/[1+e-(9.36250-1625Alb-0.0234BPC)]，敏感性和特异性分别为83.3%和65.0%。
67.8%的ALT轻度升高的CHB患者存在肝脏组织的显著损伤。40岁以上的CHB患者显著肝纤维化和中度至重度肝损伤明显增加。该回归方程对于预测CHB患者是否需要抗病毒治疗具有重要价值。
